Environment is a major determinant of health. Just
how “major” depends on how broadly “environmental” is defined: one study
estimates that about a quarter of all disease worldwide is due to environmental
factors.[1]
Locally, there are clear indications that the Pittsburgh region, once famous
for having “cleaned up its act” as one of the most polluted places in the
country, has been backsliding over the last decade or two in terms of certain
aspects of environmental health, including, for example, air quality and urban
sprawl. For example, in a recent comparison of air pollution among the 50
largest U.S. metropolitan
areas, Scorecard.org recently ranked Pittsburgh as having the 18th
worst air in the nation,[2]
while the Brookings Institute’s “Back to Prosperity” found that, as measured by
land urbanized per new household, the Pittsburgh Metropolitan Area is by far
the worst sprawling area in the country.[3] Despite these indications, certain key
questions remain difficult to answer. For example, what is the current local
burden of disease related to various environmental factors? How does this
burden of disease in the Pittsburgh
region compare to that seen in other parts of the country? How is it changing
over time? Do certain communities in our region bear more of this burden than
others? How can policy-makers, organizations and communities prioritize local
environmental health problems so as to act most effectively to solve them?

Before we can begin to try to answer these
questions, or even to know whether they are in fact answerable, it is first
advisable to examine the types and quality of existing environmental health
data. If available, such data would certainly be useful, for example, in
helping make decisions related to:

·Personal actions,

·Planning a research agenda to better understand an issue,

·Design of specific programs to address an issue,

·Policy-making, and

·Funding strategies.

This report, then, is an effort to begin to lay the
groundwork for an understanding of the data and data gaps related to local
environmental health, so as to allow such decision-making to be better informed
by the available data, as well as to prioritize areas where efforts to gather
better data are most needed.

In order to facilitate effective improvement of
environmental health in local communities, we wanted to first holistically
examine the available evidence base. What information do we already have?
What other information do we need? These were our questions going into this
endeavor.

As we proceeded in attempting to answer them, we
realized that several very recent or currently-in-progress reports and
endeavors either a) already describe the availability and quality of a particular
type of data in great detail, b) include a partial data availability inventory
as part of a broader endeavor, or c) plan to conduct similar activities on a
larger geographic level. We thus reassessed the project focus, shifting away
from covering the finer details of the data to an initial focus on “making sure
the left hand is aware of the right,” and providing descriptions of and
references to existing works and endeavors.

Our goal in producing this report in its present
form is to create the “to do” for a consolidated information inventory and data
needs assessment that will serve the following purposes for environmental
health researchers, citizens, funders and policy makers in the Pittsburgh
region:

·Provide an overview of the sources of environmental health information
in one place, along with an understanding of pertinence and interconnectedness
of these sources

·Illustrate the large volume of information that is already available,
and where much of it can be obtained, to lessen information seeking time and
duplication of effort

·Describe some of the major strengths and weaknesses of existing
information

·Outline some of the major gaps in information, so that we collectively
know where the greatest efforts will be needed to fill them

·Highlight related data compilation, linkage and analysis endeavors, so
that organizations may share resources and avoid duplication of efforts

Project Scope

As is well-known, health is defined in the World
Health Organization’s Constitution as “a state of complete physical, mental and
social well-being and not merely the absence of disease or infirmity.”[4]
Also according to the World Health Organization, “environmental health comprises
those aspects of human health, including quality of life, that are determined
by physical, chemical, biological, social, and psychosocial processes in the
environment. It also refers to the theory and practice of assessing,
correcting, controlling, and preventing those factors in the environment that
can potentially adversely affect the health of present and future generations.”[5]

It is clear that these WHO definitions of “health”
and of “environmental health” are broad. Yet having the full range of
environmental health issues on the table is important for a truly
community-based approach to environmental health. It is the communities
themselves who then help program personnel to define the environmental health
issues that are important, to decide which of these issues should be addressed,
and to plan how best to address these issues.

Because of limitations of time and resources, this
report has attempted to be comprehensive in outlook, yet strategic in focus. It
is recognized that the information contained in this report is not by any means
a complete picture of environmental health in the Pittsburgh region. This document is thus
presented as a work in progress that we nevertheless hope may serve as a
strategic guide for funding research and service programs dedicated to
improving local environmental health.

This report covers local data related to the
following areas of environmental health:

Outdoor air pollution

Water pollution

Land-based pollution

Chemical hazards

Some problems of the
built environment: (e.g., sprawl, “bad neighborhoods”)

Even within these areas of focus, this report, like
the available data, does not cover the full set of environmental toxins,
pollution sources, exposure pathways, environmentally-related health outcomes
or economic considerations. In addition, within each area the present
report has focused on certain subtopics as examples. For example, we focus on
the data related to the built environment at the neighborhood level, omitting
any discussion of indoor environments.

We note here also, although we do not further
explore them in this report, the following dimensions of environmental health:

Global-Local
Linkages

Certain local issues may have large-scale or global
environmental health implications (e.g., transportation as it affects global
warming), and certain large-scale or global environmental health issues may
have local implications, either presently or in the future (e.g., ozone
depletion, global warming, acid rain, loss of biodiversity).

Future
Generations

Environmental health is concerned with the health
and well-being of future generations as well as present populations.

Social
Environments

Unhealthy relationships with other people and the
world around us (e.g., isolation, abuse, dependency, alienation, lack of
control) as well as negative large-scale socio-cultural, macroeconomic, and
political influences (e.g., racism, disenfranchisement, marginalization,
exploitation) may clearly lead to mental illness, lowered resistance or
predisposition to physical illness, substance abuse, violence, and other health
problems.

Geographic Focus

In the present document, our geographic focus is
Southwestern Pennsylvania, with the greatest emphasis placed upon Pittsburgh and AlleghenyCounty. In deciding
on the geographic focus of this project, we weighed several factors. On the one
hand, it made sense to focus on a smaller area because 1) the Pittsburgh metropolitan area has the greatest
population density, and thus the greatest exposure risk, 2) a clear focus on
our part would be likely to be more useful for our audience, and 3) different
geographies have their own information systems. On the other hand, it
also made sense to view these issues regionally because a) pollution does not
stop at municipal or county boundaries, often traveling across several states,
b) although rural areas may be more sparsely populated, certain types of
exposures may be much higher in these areas, c) economies of scale may be achieved
by pooling resources, which is especially important within the current funding
environment, d) many organizations build their information systems around
reporting requirements, reporting upwards to state and national-level agencies
that seek homogeneity of systems across jurisdictions, and e) many local
datasets can be obtained only from state and
federal-level agencies.

Note that, while the definitions of the Southwestern
Pennsylvania “region” for certain key agencies (the Southwestern Pennsylvania
Commission, the Pennsylvania Department of Environmental Protection, and the
Pennsylvania Department of Health) fall within the same 12 counties, they
are slightly different (see Appendix B:
Counties in Definitions of “Region”). Thus, although we speak generically
of Southwestern Pennsylvania, we do not use
a steadfast definition of the region in this report.

The organization of this report reflects the idea that
interactions between environments and people occur in both directions:

ENVIRONMENTS <===>
PEOPLE

The various sources of data relating environmental
pollutants to human health outcomes may thus be placed along nodes in the
following model:

As a specific example, here is this model as it
might apply to data relating mercury from power plants and neuro-cognitive
impairment in children:

Despite our adoption of this model as the framework
for much of the classification of data in this report, we recognize several of
its limitations. For example, the model represents only one greatly simplified
chain of events within a complex system. In reality, (1) multiple sources
typically release multiple toxins for multiple underlying reasons, (2) a given
toxin may produce multiple health outcomes to a varying degree in susceptible
populations, and (3) a given health outcome may be caused by multiple toxins.
In addition, the model does not take into account a host of other important
contexts, conditions, and confounders, such as, for example, environmental and
other factors contributing to exposures, or to susceptibility.

If sufficient information and resources were
available, a more ideal approach would be to consider the data for a given
environmental health issue within an “eco-social” model constructed for that
particular issue which would consider its ecological and social contexts. An
eco-social model would look, for example, at consumer demands and polluting
activities in the contexts of economic and legal issues, pollutant
releases in the contexts of cost and technological issues, exposures of
susceptible populations in the contexts of environmental justice issues and
socio-economic issues, and health outcomes in the contexts of health
education, co-morbidities and other factors affecting resistance, and access to
health care.

Moreover, this model does not easily apply to many
problems of the built environment, let alone most problems of the social
environment. For this reason, in our discussion of data related to the built
environment and health, we have adopted a different framework for presenting
our preliminary findings.

Once all these limitations are recognized, the
cyclical model nevertheless remains useful as a first approximation of an
organizing principle for describing much of the universe of available local
environmental health data. We therefore present the remainder of this report in
the following order:

Consumer Demands and Polluting Activities

Source and Release Monitoring and Emissions Estimates

Environmental Monitoring (Potential Exposure)

Human Exposure

Health Outcomes

Built Environment

Note that built environment factors do not always
fit the source-pathway-exposure-outcome model. Amenities, for example,
may fit an “asset availability-awareness-behavior-outcome” model. This
has implications for the types of data that can be collected, and so the Built
Environment Section is self-contained.

Depth of Information

Due to its broad scope, this report is intended
merely as a starting point for future information collection and
discussion. In preparing this report, as we continued to learn of new
organizations, working groups, reports and websites, we realized the following:

·It would be impossible to interview more than a small portion of the
pertinent stakeholders and experts.

·Within specific areas of data, there was not enough time or space to
include all pertinent expertise, or to learn about it well enough to explain it
completely. For example, some of the individuals with whom we spoke for
an hour had spent decades of their career dealing with specific aspects of air
quality monitoring, or specific types of diseases.

·As datasets evolve, web links change, and new information becomes
available, the value of a “static” report will rapidly diminish.

·A more comprehensive data inventory, including finer detail such as
specific variables within datasets, is needed, but will take significantly more
effort and is better suited for a more easily updateable and queryable format
(e.g., an online database).

For some types of information that we initially
hoped to include, we did not receive responses to our initial requests for more
in-depth information, and didn’t have time to continue follow-ups. This
may be an indicator of limited staff resources in some agencies, and will
likely influence others’ ability to obtain information.

Additionally, we do not attempt to cover the
political and legislative background behind the data collection in great depth,
because we didn’t want to speak out of ignorance on complex issues and
jeopardize important existing and potential relationships or
collaborations. However, we recognize that this type of context does
often impact the availability and quality of data, sometimes leaving
individuals within organizations feeling like their hands are tied regarding
what they can share, or leaving them with too little funding and staff
resources to maintain the quality of data they’d like to.

We envision this report as the template for what
may become a “living document.” This might, for example, take the form of
a Wiki, an online document that allows individuals to make updates to a “shared
community document” from any web browser.[6] Alternately, the information
from this document might be added to one of the dynamic online information
systems already being designed by local or state organizations.